Skip to main content

Advertisement

Log in

Tendinopathy

  • Musculoskeletal Rehabilitation (NA Segal, Section Editor)
  • Published:
Current Physical Medicine and Rehabilitation Reports Aims and scope Submit manuscript

Abstract

Chronic tendon injuries are a common cause of pain and of restriction of sports or daily life. Even though a number of published studies have focused on tendon injuries, healing and treatment, the pathogenesis still remains enigmatic. The pathogenesis of chronic tendon injuries is considered multifactorial, however the precise role of each predisposing factor remains incompletely understood. The association between tendinopathy and pain should also be clarified, as the presence of tendinopathic lesions does not always lead to symptoms, but they are the necessary pre-existing conditions for spontaneous tendon ruptures. In this article, the histological features, the pathogenetic theories of tendinopathy, and the possible sources of pain are reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Magnusson SP, Langberg H, Kjaer M. The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol. 2010;6:262–8.

    Article  Google Scholar 

  2. Kaux JF, Forthomme B, Goff CL, Crielaard JM, Croisier JL. Current opinions on tendinopathy. J Sports Sci Med. 2011;10:238–53.

    PubMed  PubMed Central  Google Scholar 

  3. American Academy of Orthpoedic Surgeons. Rotator cuff tears. OrthoInfo 2011. http://orthoinfo.aaos.org/topic.cfm?topic=A00064.

  4. Maffulli N, Giai Via A, Oliva F. Chronic achilles tendon disorders: tendinopathy and chronic rupture. Clin Sports Med. 2015;34(4):607–24.

    Article  Google Scholar 

  5. Maffuli N, Wong J, Almekinders LC. Types and epidemiology of tendinopathy. Clin Sports Med. 2003;22(4):675–92.

    Article  Google Scholar 

  6. Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy. 1998;14:840–3.

    Article  CAS  Google Scholar 

  7. Rees JD, Stride M, Scott A. Tendons—time to revisit inflammation. Br J Sports Med. 2014;48:1553–7.

    Article  Google Scholar 

  8. Rompe JD, Furia JP, Maffulli N. Mid-portion Achilles tendinopathy: current options for treatment. Disabil Rehabil. 2008;30:1666–76.

    Article  Google Scholar 

  9. Giai Via A, De Cupis M, Spoliti M, Oliva F. Clinical and biological aspects of rotator cuff tears. Muscles Ligaments Tendons J. 2013;3:70–9.

    Article  Google Scholar 

  10. Battery L, Maffulli N. Inflammation in Overuse Tendon Injuries. Sports Med Arthrosc Rev. 2011;19:13–217.

    Article  Google Scholar 

  11. •• Hast MW, Abboud JA, Soslowsky LJ. Exploring the role of hypercolesterolemia in tendon health and repair. Muscles Ligaments Tendons J. 2014;4:275–9. This article is of major importance because showes the influence of hypercolesterolemia on tendon omeostasis and tendon healing.

    Article  Google Scholar 

  12. •• Snedeker JG, Gautieri A. The role of collagen crosslinks in aging and diabetes: the good, the bad and the ugly. Muscles Ligaments Tendons J. 2014;4:303–8. Many patients who suffered a tendinopathy or tendon rupture, like Achilles tendinopathy, Achilles tendon rupture or a rotator cuff tear are also diabetic. This article is of major importance because shows the influence of hypercolesterolemia on mechanical properties of tendons and it may predispose tendons to injury.

    Article  Google Scholar 

  13. Li Y, Fessel G, Georgiadis M, Snedeker JG. Advanced glycation end-products diminish tendon collagen fiber sliding. Matrix Biol. 2013;32:169–77.

    Article  CAS  Google Scholar 

  14. Frizziero A, Vittadini F, Gasparre G, Masiero S. Impact of oestrogen deficiency and aging on tendons: concise review. Muscles Ligaments Tendons J. 2014;4:324–8.

    Article  Google Scholar 

  15. Maffulli N, Waterston SW, Squair J, Reaper J, Douglas AS. Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med. 1999;9:157–60.

    Article  CAS  Google Scholar 

  16. Lemoine JK, Lee JT, Trappe TA. Impact of sex and chronic resistance training on human patellar tendon dry mass, collagen content, and collagen cross-linking. Am J Physiol Regul Integr Comp Physiol. 2009;296:119–24.

    Article  Google Scholar 

  17. Tsai WJ, McCormick KM, Brazeau DA, Brazeau GA. Estrogen effects on skeletal muscle insulin-like growth factor 1 and myostatin in ovariectomized rats. Exp Biol Med (Maywood). 2007;232:1314–25.

    Article  CAS  Google Scholar 

  18. Hansen M, Miller BF, Holm L, et al. Effect of administration of oral contraceptives in vivo on collagen synthesis in tendon and muscle connective tissue in young women. J Appl Physiol. 2009;106:1435–43.

    Article  CAS  Google Scholar 

  19. Hansen M, Couppe C, Hansen CS, et al. Impact of oral contraceptive use and menstrual phases on patellar tendon morphology, biochemical composition, and biomechanical properties in female athletes. J Appl Physiol. 1985;2013(114):998–1008.

    Google Scholar 

  20. Strickland SM, Belknap TW, Turner SA, Wright TM, Hannafin JA. Lack of hormonal influences on mechanical properties of sheep knee ligaments. Am J Sports Med. 2003;31:210–5.

    Article  Google Scholar 

  21. Slauterbeck J, Clevenger C, Lundberg W, Burchfield DM. Estrogen level alters the failure load of the rabbit anterior cruciate ligament. J Orthop Res. 1999;17:405–8.

    Article  CAS  Google Scholar 

  22. Heinemeier KM, Mackey AL, Doessing S, et al. GH/IGF-I axis and matrix adaptation of the musculotendinous tissue to exercise in humans. Scand J Med Sci Sports. 2012;22:e1–7.

    Article  CAS  Google Scholar 

  23. Nielsen RH, Clausen NM, Schjerling P. Chronic alterations in growth hormone/insulin-like growth factor-I signaling lead to changes in mouse tendon structure. Matrix Biol. 2014;34:96–104.

    Article  CAS  Google Scholar 

  24. Duncan WS. The relationship of hyperthyroidism and joint conditions. J Am Med Assoc. 1928;91:1779.

    Article  Google Scholar 

  25. •• Oliva F, Osti L, Padulo J, Maffulli N. Epidemiology of the rotator cuff tears: a new incidence related to thyroid disease. Muscles Ligaments Tendons J. 2014;4:309–14. This article is of importance because it reported an higher incidence of rotator cuff tears in patients with hypothyroidism, showing a significant correlation between thyroid disease and tendon injury.

    Article  Google Scholar 

  26. •• Oliva F, Berardi AC, Misiti S, Verza Felzacappa C, Iacone A, Maffulli N. Thyroid hormones enhance growth and counteract apoptosis in human tenocytes isolated from rotator cuff tendons. Cell Death Dis. 2013;4:e705. It is and in vitro study which demonstrate the presence of THs receptors both in healthy and pathological tendons. It is of major importance because it first showed the influence of TH on tendon homeostasis and tenocytes proliferation.

    Article  CAS  Google Scholar 

  27. Berardi AC, Oliva F, Berardocco M, La Rovere M, Accorsi P, Maffulli N. Thyroid hormones increase collagen I and cartilage matrix protein (COMP) expression in vitro human tenocytes. Muscles Ligaments Tendons J. 2014;4:285–91.

    Article  Google Scholar 

  28. Magra M, Maffulli N. Genetics aspects of tendinopathy. J Sci Med Sport. 2008;11:243–7.

    Article  Google Scholar 

  29. Magra M, Maffulli N Genetics: Does it play a role in tendinopathy? Clin J Sport Med 2007.

  30. Sai-Chuen F, Rolf C, Yau-Chuk C, Lui P PY, Kai-Ming C. Deciphering the pathogenesis of tendinopathy: a three-stage process. Sports Med Arthrosc Rehabil Ther Technol. 2010;2:30.

    Google Scholar 

  31. Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am. 2005;87:187–202.

    PubMed  Google Scholar 

  32. Sharma P, Maffulli N. Biology of tendon injury: healing, modeling and remodeling. J Musculoskelet Neuronal Interact. 2006;6:181–90.

    CAS  PubMed  Google Scholar 

  33. van Sterkenburg M, van Dijk N. Mid-portion Achilles tendinopathy: why painful? An evidence-based philosophy. Knee Surg Sports Traumatol Arthrosc. 2011;19:1367–75.

    Article  Google Scholar 

  34. Alfredson H, Ohberg L, Forsgren S. Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis? An investigation using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Knee Surg Sports Traumatol Arthrosc. 2003;11:334–8.

    Article  Google Scholar 

  35. Gustav A, Patrik D, Hakan A, Sture F. Nerve-related characteristics of ventral paratendinous tissue in chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc. 2007;15:1272–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nicola Maffulli.

Additional information

This article is part of the Topical Collection on Musculoskeletal Rehabilitation.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Giai Via, A., Papa, G., Oliva, F. et al. Tendinopathy. Curr Phys Med Rehabil Rep 4, 50–55 (2016). https://doi.org/10.1007/s40141-016-0112-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40141-016-0112-y

Keywords

Navigation